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Listen Up: It Is All About Personal Responsibility

Stanley Feld M.D.,FACP,MACE

In my last blog I continued my War on Obesity. I started this war in 2007.

There has been little progress in this war because of cultural conditioning and a lack of emphasis on personal responsibility.

Every New Year’s Day millions of Americans make New Year resolutions to lose weight. They are initially successful. They then regain the weight they have lost.

If America is going to solve the healthcare systems unsustainable cost, it is going to have to solve the increasing Obesity problem.

The National Institute of Diabetes (niddk.nih} recently published Overweight and Obesity statistics:

  “More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

 “ More than one-third (35.7 percent) of adults are considered to be obese.”

 “ More than 1 in 20 (6.3 percent) have extreme obesity.”

 “ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”

Each year the obesity problem gets worse. Companies have sprung up selling weight loss formulas. These companies advertise their great success.

However, most of the iconic personalities used in their advertising have regained their weight after experiencing mild or significant weight loss.

This study was conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

NHANES III was designed to provide nationally representative data to estimate the prevalence of major diseases, nutritional disorders, and potential risk factors.

  • Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater.


  • A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women.


  • With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8)


  • Women (PR, 12.9; 95% CI, 5.7-28.1]


  •  Gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9).


  • Prevalence ratios generally were greater in younger than in older adults.


  • The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.


The Prevalence Ratio of Obesity and Type 2 Diabetes is 18.1 for men and 12.9 for women.

Therefore Type 2 Diabetes is very prevalent in both Obese and Overweight men and women.


  • Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance.
  • Hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications.
  • These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease.
  • Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy.

Eighty percent of the treatment costs for diabetes and hypertension to the healthcare system is the result of the treatment of the complications of hypertension and diabetes.

In order for a healthcare system to be sustainable diabetes and hypertension must be cured. It is essential that each must be recognized early and treated aggressively.

Patients must be taught to be “the professor of their disease” so they can self-manage the control of their disease. Blood pressures and blood sugar are changing continuously. Patients live with their disease 24/7.

This takes a lot of personal responsibility and personal discipline.

Equally important is the morbidity resulting from the complications of diabetes and hypertension, two diseases that result from obesity.

Complications from the onset of both hypertension and diabetes take about eight years to develop. This is the reason to diagnose and discover Pre-Diabetes at the onset.

  • The shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for non-pharmacological intervention.
  • Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification.

Lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders.

This is the where my story of the importance of personal responsibility comes in.

A restaurateur, in his early 50’s, who runs a large restaurant in Dallas, that I frequent, was slowly gaining weight. At 269 lbs. he had difficulty standing on his feet all day long. He was being treated for hypertension and hyperlipidemia (high cholesterol).

His physician told him he must lose weight. He informed him of his risk factors for the complications of these diseases.

This was all he needed hear. The thought of having to quit the job he loved and the possibility of dying from the complications of his diseases was enough to make him decide to loss the weight.

He was told he would be fine if he lost the weight.

He has lost 70 far without assistence. He has decided to be personally responsible for his weight loss.

He now gets up at 5 am each morning and exercises for one hour each day before work.

He has stopped eating his wonderful pasta dishes. He eats nothing that is white.

Every time I meet a friend at the restaurant, the restaurateur sits down at our table for a chat. We usually talk about how great he is doing in the weight loss department.

I had initiated an obesity program at Endocrine Associates of Dallas P.A. in the mid 1980s. A California clinical endocrinologist, with whom I did my endocrine fellowship with, had a very successful obesity program. He convinced me to start one at EAD.

Patients on large doses of insulin were totally off insulin after two weeks. It was successful until the patients graduated from the program.

Unfortunately the recidivism rate (regaining weight) was around 80%. This rate was not dissimilar to the national overage at the time.

EAD stopped the program.

In my view there were not enough patients who turned the corner and stuck to the program.

I believe the restaurateur has turned the corner. This fellow has turned the personal responsibility corner to control his food intake and exercise output. I do not believe he will regain his weight.

He has exhibited personal responsibility for his health and well-being.

If only physicians could solve the obesity problem so easily, the cost of healthcare would plummet to sustainable levels.

The development of Type 2 Diabetes Mellitus would also plummet and the cost of the treatment of its complications would vanish.

Social change is necessary in restaurants and fast food chains.

People have to be taught to eat wisely in restaurants and at home.

People have to be provided with education about the perils of obesity.

People have to understand the natural history of obesity.

People have to be motivated to not only maintain their health. They have to be given financial incentives to control their health.

This can only be achieved with a consumer driven healthcare system in which people are provided with incentives to control their healthcare dollars.

My ideal medical savings account will provide all the appropriate incentives for all people of all economic levels.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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War on Obesity: Pre Diabetes Part 20

 Stanley Feld M.D.,FACP, MACE

This is a continuation of my War on Obesity.

The New York Times has criticized Donald Trump’s healthcare plan without even knowing what is in it.

I hope all the features of a healthcare plan missing from President Obama’s healthcare plan are included in President Trump’s healthcare plan. I believe Dr. Tom Price knows most of what needs to be included. He also knows that Obamacare is a disaster. It must be repealed.

I have written a series of articles outlining what should be included President Trump’s replacement healthcare plan after he repeals Obamacare.

I believe the critical element necessary for Repairing the Healthcare System is the development of a healthcare system in which consumers are responsible for their health and healthcare dollars.

This is the main reason Obamacare needs to be repealed. Obamacare makes consumers of healthcare dependent on the government and less responsible for their own healthcare.

Joan Colgin R.N. was Endocrine Associates of Dallas P.A.’s first fulltime Diabetes Educator. I nominated her for Diabetes Educator of the year some years back. She came out second to a woman who was trying to provide diabetes education to an indigent population. Endocrine Associates of Dallas P.A. was providing effective Diabetes Education on a one on one basis to consumers of all socioeconomic groups.

Joan provided Diabetes education to all people who were interested in learning to be responsible for the self-management of their Diabetes Mellitus. Patients live with their disease 24 hours a day and must learn how to manage it.

Endocrine Associates of Dallas P.A. was extremely successful in motivating people to be responsible for their own care.

Joan is presently the nurse member of the Texas Diabetes Council. Recently she asked me to publicize the CDC’s new position statement on Pre-Diabetes.

The National Institute of Diabetes (niddk.nih} published Overweight and Obesity statistics:

  “More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

 “ More than one-third (35.7 percent) of adults are considered to be obese.”

 “ More than 1 in 20 (6.3 percent) have extreme obesity.”

 “ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”


My personal observation has been that 80% of patients in the Cardiac ICU have Type 2 Diabetes. Almost all have Type 2 Diabetes that was just discovered on this admission to the hospital.

We know the complications of Type 2 Diabetes Mellitus take at least 8 years after the onset of the disease to occur.

The Cardiac ICU patients either had Pre Diabetes (asymptomatic) or undiscovered Type 2 Diabetes Mellitus (also asymptomatic) for at least 8 years prior to their heart attacks.

The CDC position paper can be extremely helpful in reducing the cost of medical care to our healthcare system if it is rolled out effectively.

Eighty percent of our healthcare dollars are spent on the complications of all chronic diseases. Type 2 Diabetes Mellitus is the most prevalent.

The summary of the position paper is as follows:

“What Prediabetes is Trying to Tell You”

Did you know that people can have prediabetes for years without any clear symptoms?

It often goes unnoticed until serious health problems show up, like type 2 diabetes or heart disease.

But if you find out you have prediabetes early, you could make lifestyle changes proven to help safeguard your health.

Knowing your risk is the first step. If you have any of these risk factors for prediabetes, don’t wait—talk to your doctor about getting your blood sugar tested:

  • Being overweight
  • Being 45 years or older
  • Having a parent or sibling with type 2 diabetes
  • Being physically active less than 3 times a week
  • Ever having gestational diabetes (diabetes while pregnant) or giving birth to a baby who weighed more than 9 pounds
  • Being African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian American 
  • Want to find out your risk right now? Take the 1-minute quiz at organd be sure to share the results with your doctor.

 The summary is all you have to know. is an excellent questionnaire that takes two minutes to complete to determine if you are at risk for Type 2 Diabetes.

The CDC division of Diabetes Prevention includes a detailed position statement entitled:

The Surprising Truth About Prediabetes

The first sentence says it all!

It’s real. It’s common.

And most importantly, it’s reversible.

You can prevent or delay prediabetes from developing into type 2 diabetes with simple, proven lifestyle changes.

 The reason for the statement is simple to understand. We are all born with an inherited genetic make-up. About 33% of us have the genetic make-up that predisposes us to Type 2 Diabetes Mellitus.

Obesity will bring out the tendency to develop Type 2 Diabetes Mellitus by causing us to be resistant to our own insulin.

Our body in response to exposure to sugar secretes our insulin. If we are resistant to our own insulin our sugar level will increase to the point of officially having Type 2 Diabetic Mellitus.

America has an Obesity Epidemic.

“More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

Americans are constantly exposed to too many calories. The only way to gain weight is to eat more than you burn. The only way to lose weight is to eat less and burn more.

One third of those 68.8 percent of obese people will get Type 2 Diabetes unless they lose weight to prevent its onset.

Unless those people lose weight they will be destined to suffer the morbidity and mortality resulting from Type 2 Diabetes Mellitus.

The only one in control of a person’s weight is that person. This is the reason that individuals must be responsible for their own care.

The government cannot provide weight loss. The government can provide education and incentives for individuals to be responsible for their own care.

Preventing the onset of Type 2 Diabetes will precipitously decrease the cost of medical care.

This is the reason a consumer driven healthcare system with consumers being responsible for their care is vital to a successful healthcare system.

I hope President Trump and all of congress is listening.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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